Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Department of Women's Health, Danderyd Hospital, Stockholm, Sweden.
Acta Obstet Gynecol Scand. 2023 Mar;102(3):378-388. doi: 10.1111/aogs.14513. Epub 2023 Jan 24.
Severe perineal injuries at childbirth affect women's postnatal health, including future childbirths. First births with vacuum extraction carry an increased risk of obstetric anal sphincter injuries (OASIS). Lateral or mediolateral episiotomy at vacuum extraction may decrease the risk of OASIS. Our aim was to assess whether lateral or mediolateral episiotomy, or OASIS, at vacuum extraction in nulliparous women is associated with prelabor cesarean delivery in the subsequent childbirth.
This is a nationwide observational study using data from the Swedish Medical Birth Register, including women having a first birth with vacuum extraction and a second birth in 2000-2014. Both births were live, single, cephalic, ≥34 gestational weeks without malformations. The association between episiotomy or OASIS in the first birth and prelabor cesarean delivery in the second birth was examined using univariate and multivariate logistic regression with inverse probability of treatment weighting, and interaction analysis. Main outcome measure was prelabor cesarean delivery in the second birth.
In total, 44 656 women with vacuum extraction at their first birth were included. The rate of prelabor cesarean delivery in the second birth was 5.9% (824 of 13 950) in women with episiotomy, compared with 6.0% (1830 of 30 706) in women without episiotomy. Thus, women with episiotomy did not have an increased risk of prelabor cesarean delivery (adjusted odds ratio [aOR] 1.00, 95% confidence interval [95% CI] 0.83-1.20) compared with women without episiotomy. For comparison, the rate of prelabor cesarean delivery in the second birth was 20.6% (1275 of 6176) in women with OASIS, compared with 3.6% (1379 of 38 480) in women without OASIS (aOR 6.57, 95% CI 5.97-7.23). There was no interaction between episiotomy and OASIS.
Lateral or mediolateral episiotomy at vacuum extraction in nulliparous women did not increase the risk of prelabor cesarean delivery in the subsequent childbirth. OASIS increased the odds of prelabor cesarean delivery more than sixfold.
分娩时严重的会阴损伤会影响女性产后健康，包括未来的分娩。真空吸引分娩的初产妇发生产科肛门括约肌损伤（OASIS）的风险增加。在真空吸引分娩时行会阴侧切或会阴正中切开术可能会降低 OASIS 的风险。我们的目的是评估初产妇行真空吸引分娩时行会阴侧切或会阴正中切开术或发生 OASIS 是否与随后分娩时的产前剖宫产有关。
这是一项全国性观察性研究，使用瑞典医学出生登记处的数据，包括首次行真空吸引分娩且在 2000-2014 年期间再次分娩的女性。两次分娩均为活产、单胎、头位、≥34 孕周且无畸形。使用逆概率治疗加权的单变量和多变量逻辑回归以及交互分析，评估首次分娩时行会阴侧切或 OASIS 与随后分娩时的产前剖宫产之间的关系。主要结局指标为再次分娩时的产前剖宫产。
共纳入 44656 名首次行真空吸引分娩的女性。行会阴侧切的女性中，再次分娩时的产前剖宫产率为 5.9%（824/13950），而行会阴侧切的女性中为 6.0%（1830/30706）。因此，行会阴侧切的女性与未行会阴侧切的女性相比，产前剖宫产的风险没有增加（校正比值比[aOR]1.00，95%置信区间[95%CI]0.83-1.20）。相比之下，发生 OASIS 的女性中，再次分娩时的产前剖宫产率为 20.6%（1275/6176），而未发生 OASIS 的女性中为 3.6%（1379/38480）（aOR 6.57，95%CI 5.97-7.23）。会阴侧切和 OASIS 之间没有交互作用。
初产妇行真空吸引分娩时行会阴侧切或会阴正中切开术不会增加随后分娩时的产前剖宫产风险。OASIS 使产前剖宫产的可能性增加了六倍以上。
